The present disclosure generally relates to the field of endoscopes and video endoscopes. More particularly, the present disclosure relates to endoscopes that are arranged to be used in the field of intubation, such as video intubation endoscopes.
More particularly, in one exemplary aspect, the present disclosure relates to a video endoscope, the endoscope comprising a shaft comprising a rigid, proximal-side section and a distal section that is laterally deflectable in a plane from the central longitudinal axis of the shaft, wherein an imager and an illuminator are arranged at the distal end of the deflectable section, and wherein a housing is arranged at the proximal end of the shaft, wherein the housing comprises a control element for controlling the deflection of the shaft, wherein a rod-like pull element extends in the shaft in a fashion off-center with respect to the central longitudinal axis, wherein the pull element is, at the proximal side thereof, coupled with the control element and, at a distal side thereof, coupled with the distal end region of the deflectable distal section of the shaft, wherein a movement of the pull element by the control element in the proximal direction effects a lateral deflection of the deflectable section, wherein the rod-like pull element extends into a clearance space in the interior of the housing through a first opening at the proximal end of the shaft, wherein the proximal end of the pull element is coupled with the control element in the clearance space.
An intubation endoscope of that kind is known from U.S. Pat. No. 6,319,195 B1.
For intubation, particularly for emergency intubation, instruments are required by which means for ventilating the patient may be inserted in the trachea as quickly as possible. Emergency situations of that kind particularly occur after accidents in which the trachea and, as a consequence, the respiration of the patient is strongly restricted or entirely blocked. In particular, emergency situations of that kind occur in connection with work accidents, road accidents and particularly motor cycle accidents. For such an emergency intubation, an instrument needs to be provided which is preferably operable in a simple and reliable fashion.
To this end, intubation endoscopes have been developed. In some exemplary embodiments, an intubation tube is made from transparent plastic material may be placed on the distal end region of such an intubation endoscope, wherein the intubation tube may be inserted into the trachea with that intubation endoscope, involving visual observation. Having inserted the intubation tube, the intubation tube in inflated so that the intubation tube is arranged to remain fixed on location in the trachea. Subsequently, the intubation endoscope is pulled off from the inserted tube. Thereafter, the tube is coupled with a hose of a ventilation apparatus by means of which ventilation air subsequently may be supplied to the trachea.
In such intubation cases, often minutes or even seconds determine whether the patient may be ventilated again in time such that the survival of the patient may be ensured.
Further, there is a desire to provide the shaft of the intubation endoscope with a diameter as small as possible so that a correspondingly greater and more stable intubation tube may be attached thereon and inserted into the trachea. As the anatomical structure for the intubation of human patients are widely similar, an endoscope is used which comprises a rigid straight shaft region, the distal end region of which is laterally deflectable. Due to the anatomy of humans, an endoscope having a distal deflection in only one direction is sufficient. It is more favorable, in terms of ergonomics, to use such an endoscope that is merely deflectable in a single direction than using systems providing a deflection in two or potentially four directions. The intubation endoscope is initially, having a straight orientation, inserted in the oral cavity towards the larynx and, thereafter, the deflectable section is curved in a manner that corresponds to the transition of the oral cavity via the larynx to the trachea of the respective patient.
A further requirement is that the endoscopic visualization system is preferably small in diameter so as to provide a sufficient cross-sectional surface for the intubation tube for ventilation. In accordance with the afore-mentioned U.S. Pat. No. 6,319,195 B1, a correspondingly slender elongated shaft is formed the distal end region of which is laterally deflectable in one direction. To this end, a basically rod-like pull element is arranged in the interior in a fashion offset from the central longitudinal axis of the shaft, wherein the distal end of the pull element is coupled with the deflectable region. The proximal end of the pull element is fed through an opening into an inner clearance space of a housing which is arranged at a proximal-side end of the shaft. At the housing, a laterally projecting control element that forms a control lever is provided, the inner end of which extends in the interior space, namely in the clearance space, and is coupled therein with the proximal end of the pull element. In the linearly straightened state of the shaft, the lever laterally projects from the housing. When the lever approaches the housing, the proximal end of the pull element is pulled in the proximal direction into the inner clearance space of the housing. This consequently involves that the flexible section of the shaft is laterally deflected.
The resetting of the deflected shaft to the rectilinear state is performed by a rebound element arranged in the interior of the shaft, wherein the rebound element is arranged as an elastic element that is coupled with the distal end region of the pull element. When laterally deflecting the shaft, a reset force is generated in the rebound element which provides for the rectilinear orientation of the shaft when the lever is released.
Depending on the configuration of the imaging and illumination system by which processes at the distal end of the shaft may be visually acquired during the intubation, also respective supply lines must be fed through the shaft, that is, light conductors, image conductors or corresponding electrical supply lines.
As the pull element is, in practical use, subjected to tension, that is, displaced in the proximal direction, the pull element may be configured to have a relatively small diameter, for instance as a slender wire body by which considerable pull forces may be applied.
When deflecting the shaft, the proximal end region of the pull element which is coupled with the control element is moved by a certain distance into the clearance space in the interior of the housing.
It has been observed with pull elements having a relatively small diameter, in practical use, that bulges or lateral deflections of the pull element may occur when aligning the shaft in a rectilinear fashion, when the portion of the pull element that is arranged in an exposed fashion in the interior is moved in the distal direction.
These bulges involve that a movement of the pull element in the distal direction for straightening the shaft or for reducing the curvature of the deflected region when adapting to the respective anatomy of the patient may be inhibited or blocked by such bulges or deflections.
In view of this it is an object of the present disclosure to address and tackle at least some of the above-mentioned drawbacks and issues.
It is another object to provide a remedy for at least some of the above-mentioned drawbacks and to present an endoscope that may be operated in an ergonomic and reliable fashion.
It is a further object to present an endoscope that also may be operated as an intubation endoscope, and wherein the back-and-forth motion of the pull element, particularly the displacement in the distal direction, is performed in a reliable fashion.